scholarly journals A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Benjamin A. Lipsky ◽  
Michael H. Silverman ◽  
Warren S. Joseph
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Classification Scheme ◽  
Regulatory Agencies ◽  
Wound Infections ◽  
Soft Tissue Infections ◽  
New Classification ◽  
Diabetic Foot Infections ◽  
The Us

Abstract Schemes for classifying skin and soft tissue infections (SSTIs) pose limitations for clinicians and regulatory agencies. Diabetic foot infections (DFIs) are a subset of SSTIs. We developed and are proposing a classification to harmonize current schemes for SSTIs and DFIs. Existing schemes for classifying SSTIs are limited in both their usefulness to clinicians and to regulatory agencies. The guidelines on SSTI from the Infectious Diseases Society of America (IDSA) and the guidance from the US Food and Drug Administration do not adequately address many types of wound infections. However, guidelines developed by the IDSA for DFIs provide a classification scheme that has been validated and widely used. Diabetic foot infections are similar to SSTIs in pathophysiology, microbiology, and treatment and can be seen as a subset of SSTI. Thus, based on the documents noted above, and our review of the literature, we have developed a proposed classification scheme for SSTI that harmonizes well with the DFI classification. We believe this new scheme will assist clinicians in classifying most wound infections and potentially aid regulatory agencies in testing and approving new antimicrobials for these infections.

scholarly journals Clinafloxacin versus Piperacillin-Tazobactam in Treatment of Patients with Severe Skin and Soft Tissue Infections

2001 ◽  
Vol 45 (2) ◽  
pp. 525-531 ◽  
Author(s):  
G. Siami ◽  
N. Christou ◽  
I. Eiseman ◽  
K. J. Tack
Keyword(s):  
Soft Tissue ◽  
Adverse Events ◽  
Clinical Cure ◽  
Wound Infections ◽  
Soft Tissue Infections ◽  
Pathogenic Species ◽  
Treatment Groups ◽  
Diabetic Foot Infections ◽  
Cure Rates ◽  
To Receive

ABSTRACT Patients (n = 409) with severe skin and soft tissue infections (SSTIs) were randomized to receive clinafloxacin or piperacillin-tazobactam (plus optional vancomycin for methicillin-resistant cocci), administered intravenously, with the option to switch to oral medication. Most patients had cellulitis, wound infections, or diabetic foot infections. Staphylococcus aureus, Enterococcus faecalis, and Pseudomonas aeruginosa were the most common baseline pathogens. Fewer baseline pathogens were resistant to clinafloxacin (1.8%) than to piperacillin-tazobactam (6.2%) (P = 0.001). The clinafloxacin and piperacillin-tazobactam groups did not differ significantly in clinical cure rates (68.8 and 65.2%, respectively) or microbiologic eradication rates (61.5 and 57.2%). Clinafloxacin yielded higher eradication rates for all three of the most common pathogenic species, although no differences were statistically significant. Within the power of this study, the overall frequency of adverse events was similar (P = 0.577) in the two treatment groups. Drug-associated adverse events (P = 0.050) and treatment discontinuations (P = 0.052) were marginally more frequent in the clinafloxacin group, primarily due to phototoxicity in outpatients receiving clinafloxacin. Although most cases of phototoxicity were mild to moderate, four cases were reported as severe. In summary, clinafloxacin monotherapy was equivalent in effectiveness to therapy with piperacillin-tazobactam plus optional vancomycin in the treatment of hospitalized patients with severe SSTIs.

Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece

2017 ◽  
Vol 16 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Maria Demetriou ◽  
Nikolaos Papanas ◽  
Periklis Panagopoulos ◽  
Maria Panopoulou ◽  
Efstratios Maltezos
Keyword(s):  
Antibiotic Resistance ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Initial Choice ◽  
Gram Positive Cocci

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

Atherosis of trophoblast type: A specific form of decidual vasculopathy distinct from atherosis of macrophage type

2021 ◽  
Author(s):  
Peilin Zhang
Keyword(s):  
Mixed Type ◽  
Classification Scheme ◽  
Late Pregnancy ◽  
Placental Weight ◽  
Placental Pathology ◽  
New Classification ◽  
Vascular Abnormalities ◽  
Medial Necrosis ◽  
Acute Atherosis

Background: There are three types of decidual vasculopathy, namely, acute atherosis, fibrinoid medial necrosis and mural arterial hyerptrophy. Persistence of vascular trophoblasts is also known to be related to maternal vascular malperfusion, but detailed study is lacking. Material and methods: A total 1017 placentas from 2021 were collected with clinical, neonatal and placental information, and routine placental pathology examination was performed. Decidual vasculopathy was classified based on the new classification scheme including atherosis of macrophage type atherosis of trophoblast type, fibrinoid medial necrosis, mural arterial hypertrophy and mixed type vasculopathy. The significance of these morphologic changes were examined based on the clinical, neonatal and placental pathology features. Results: Decidual vasculopathy is classified as classic type, mural hypertrophy and mixed type. Classic type vasculopathy is further separated as atherosis and fibrinoid medial necrosis. Atherosis is defined as atherosis of macrophage type and atherosis of trophoblast type. Each category of decidual vasculopathy was evaluated in association with maternal, neonatal and placental pathologic findings. Atherosis of macrophage type and mixed type vasculopathy showed statistically significant association with preeclampsia/pregnancy induced hypertension, low birth weight and low placental weight. Atherosis of trophoblast type was associated with lower placental weight but not with specific clinical features. There is no neonatal sex dimorphism in decidual vasculopathy. Conclusion: Atherosis of trophoblast type is a distinct pathologic feature in late pregnancy, and it is associated with lower placental weight. New classification of decidual vasculopathy helps with better stratification and categorization of placental maternal vascular abnormalities.

scholarly journals Proposal of a new classification scheme for periocular injuries

2017 ◽  
Vol 50 (01) ◽  
pp. 021-028 ◽  
Author(s):  
Devi Prasad Mohapatra ◽  
Friji Meethale Thiruvoth ◽  
Ravi Kumar Chittoria ◽  
S. Dinesh Kumar ◽  
Sudhanva Hemant Kumar ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Classification Scheme ◽  
Soft Tissue Injuries ◽  
Classification Systems ◽  
Lateral Canthus ◽  
Aesthetic Appearance ◽  
Adjacent Structures ◽  
Tissue Injuries ◽  
Comprehensive Classification

ABSTRACT Background: Eyelids are important structures and play a role in protecting the globe from trauma, brightness, in maintaining the integrity of tear films and moving the tears towards the lacrimal drainage system and contribute to aesthetic appearance of the face. Ophthalmic trauma is an important cause of morbidity among individuals and has also been responsible for additional cost of healthcare. Periocular trauma involving eyelids and adjacent structures has been found to have increased recently probably due to increased pace of life and increased dependence on machinery. A comprehensive classification of periocular trauma would help in stratifying these injuries as well as study outcomes. Material and Methods: This study was carried out at our institute from June 2015 to Dec 2015. We searched multiple English language databases for existing classification systems for periocular trauma. We designed a system of classification of periocular soft tissue injuries based on clinico-anatomical presentations. This classification was applied prospectively to patients presenting with periocular soft tissue injuries to our department. Results: A comprehensive classification scheme was designed consisting of five types of periocular injuries. A total of 38 eyelid injuries in 34 patients were evaluated in this study. According to the System for Peri-Ocular Trauma (SPOT) classification, Type V injuries were most common. SPOT Type II injuries were more common isolated injuries among all zones. Discussion: Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. The SPOT classification has taken into account the periocular soft tissue injuries i.e., upper eyelid, lower eyelid, medial and lateral canthus injuries., based on observed clinico-anatomical patterns of eyelid injuries. Conclusion: The SPOT classification seems to be a reliable system to address eyelid injuries. This classification scheme would guide the ophthalmic and facial reconstructive surgeons to provide optimal outcomes in eyelid injuries. Based on the classification scheme and review of existing literature, an algorithm is presented to facilitate repair and reconstruction.

Proposal for a New Histopathological Classification of the Carcinomas of the Nasopharynx

1978 ◽  
Vol 64 (5) ◽  
pp. 513-518 ◽  
Author(s):  
Christian Micheau ◽  
Franco Rilke ◽  
Silvana Pilotti
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Classification Scheme ◽  
Malignant Tumors ◽  
Undifferentiated Carcinoma ◽  
New Classification ◽  
Histopathological Classification ◽  
Potential Origin

A new classification scheme for malignant tumors of the nasopharynx is proposed in which the undifferentiated carcinoma of nasopharyngeal types as a prominent position. This term replaces the previous obsolete term lymphoepithelioma on the basis of its clinicopathologic identity, its separation from squamous cell carcinoma, and its potential origin from anatomical areas other than the nasopharynx.

scholarly journals Biodiversity and Classification of Lactococcal Phages

2006 ◽  
Vol 72 (6) ◽  
pp. 4338-4346 ◽  
Author(s):  
H�l�ne Deveau ◽  
Simon J. Labrie ◽  
Marie-Christine Chopin ◽  
Sylvain Moineau
Keyword(s):  
Dna Hybridization ◽  
Classification Scheme ◽  
Rapid Identification ◽  
New Classification ◽  
Sequence Analyses ◽  
Reference Center ◽  
Detection Tool ◽  
Pcr Product ◽  
Pcr Method

ABSTRACT For this study, an in-depth review of the classification of Lactococcus lactis phages was performed. Reference phages as well as unclassified phages from international collections were analyzed by stringent DNA-DNA hybridization studies, electron microscopy observations, and sequence analyses. A new classification scheme for lactococcal phages is proposed that reduces the current 12 groups to 8. However, two new phages (Q54 and 1706), which are unrelated to known lactococcal phages, may belong to new emerging groups. The multiplex PCR method currently used for the rapid identification of phages from the three main lactococcal groups (936, c2, and P335) was improved and tested against the other groups, none of which gave a PCR product, confirming the specificity of this detection tool. However, this method does not detect all members of the highly diverse P335 group. The lactococcal phages characterized here were deposited in the F�lix d'H�relle Reference Center for Bacterial Viruses and represent a highly diverse viral community from the dairy environment.

scholarly journals Hypertonic glucose inhibits growth and attenuates virulence factors of multidrug-resistant Pseudomonas aeruginosa

2020 ◽  
Author(s):  
Tao Chen ◽  
Ye Xu ◽  
Wenya Xu ◽  
Wenli Liao ◽  
Chunquan Xu ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Virulence Factors ◽  
Diabetic Foot ◽  
Biofilm Formation ◽  
Chronic Wound ◽  
Multidrug Resistant ◽  
Wound Infections ◽  
Hypertonic Glucose ◽  
Diabetic Foot Infections ◽  
Chronic Wound Infections

Abstract Background: Pseudomonas aeruginosa is the most common Gram-negative pathogen responsible for chronic wound infections, such as diabetic foot infections, and further exacerbates the treatment options and cost of such conditions. Hypertonic glucose, a commonly used prolotherapy solution, can accelerate the proliferation of granulation tissue and improve microcirculation in wounds. However, the action of hypertonic glucose on bacterial pathogens that infect wounds is unclear. In this study, we investigated the inhibitory effects of hypertonic glucose on multidrug-resistant P. aeruginosa strains isolated from diabetic foot infections. Hypertonic glucose represents a novel approach to control chronic wound infections caused by P. aeruginosa. Results: Four multidrug-resistant P. aeruginosa clinical strains isolated from diabetic foot ulcers from a tertiary hospital in China and the reference P. aeruginosa PAO1 strain were studied. Hypertonic glucose significantly inhibited the growth, biofilm formation, and swimming motility of P. aeruginosa clinical strains and PAO1. Furthermore, hypertonic glucose significantly reduced the production of pyocyanin and elastase virulence factors in P. aeruginosa. The expression of major quorum sensing genes (lasI, lasR, rhlI, and rhlR) in P. aeruginosa were all downregulated in response to hypertonic glucose treatment. In a Galleria mellonella larvae infection model, the administration of hypertonic glucose was shown to increase the survival rates of larvae infected by P. aeruginosa strains (3/5).Conclusions: Hypertonic glucose inhibited the growth, biofilm formation, and swimming motility of P. aeruginosa, as well as reduced the production of virulence factors and quorum sensing gene expression. Further studies that investigate hypertonic glucose therapy should be considered in treating chronic wound infections.

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